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Brazilian Federal Supreme Court declares constitutionalities of the obligation of health insurance plans to reimburse the Unified Health System for treatments of clients in the Public Health System

In the Direct Action for the Declaration of Unconstitutionality (ADI) 1931, the Brazilian Federal Supreme Court (STF) sitting en banc declared the constitutionality of the principal and remaining provisions of article 32 of Law 9.656/1998 (Healthcare Plans Act), which asserts that healthcare plans should compensate the entities of the Unified Health System (SUS) for the health services provided to its purchasers.

The rapporteur stressed that the treatment in a public hospital should not be denied to any person, considering the universality of the system. However, the Justice noted that if the public administration's health centers provide its services to a private healthcare plan holder in one of the situations included in the plan's contractual coverage, the SUS should be reimbursed in the same way the health plan should cover the costs in the case of a private hospital. "The article prevents the illicit enrichment of companies and the perpetuation of a model in which the health services market is moved solely by the profit rationale, even if the earnings come from the public purse" he concluded.

Read more: STF decide que regulamentação dos planos de saúde não atinge contratos celebrados antes da Lei 9.656/1998

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